Unipolar depression

Symptoms and features

What is unipolar depression?

* It is characterised by persistent low mood
* Can be single, recurrent or chronic depending on length of symptoms
* Can be mild, moderate or severe depending on how severely it impacts the individual
* Has different subtypes such as postnatal depression and seasonal affective disorder

What is the criteria for the symptoms to reach a diagnosis of depression?

* At least 5 symptoms, present for most of the day every day, for at least 2 weeks

What are the affective symptoms of depression?

* People with depression may feel sad, empty or hopeless and may be tearful while children and adolescents with depression may be irritable.
* The term anhedonia describes a lack of enjoyment or pleasure found in previously enjoyed activities, events or places
* Symptoms include: continuous low mood, feeling tearful, feeling irritable and intolerant of others, having no motivation, not getting enjoyment out of life and feeling anxious.

What are the bodily symptoms of depression?

* Another central symptom in both diagnostic systems is reduced energy levels
* This has a knock-on effect, with depressed individuals tending to withdraw from work, education and social life
* In addition, changes in appetite are listed - decreased or increased appetite leading to significant weight loss or gain (change in more than 5% of their normal body weight)
* Sleep patterns are disrupted nearly every day
* People with depression often experience insomnia, finding it hard to sleep or waking in the early hours and unable to return to sleeping. Excessive sleeping is also common.
* Symptoms include: low sex drive, lack of energy, constipation, moving or speaking more slowly than usual and changes to your menstrual cycle

What are the cognitive symptoms of depression?

* People with depression experience negative thoughts
* They blame themselves for events out of their control. They feel guilty and unworthy of other people's time and care.
* They lack confidence and feel incompetent and incapable and have a pessimistic outlook
* Symptoms include: having suicidal thoughts or thoughts of harming yourself, pessimistic outlook on life and feeling guilt-ridden

What are the behavioural symptoms of depression?

* Fatigue and loss of pleasure and enjoyment can lead to social withdrawal and diminished activity.
* Some people with depression show signs of psychomotor retardation or agitation but this must be observable by others in order to count as a symptoms

What is reactive depression?

* Depression that occurs as a reaction to a major life event e.g. death of a loved one or divorce
* Dr Ronald Pies argues that grief and depression are separate things but that doesn't mean that you can not have both if you have experienced loss. The grief may be the trigger for the depression

What is endogenous depression?

* No external precipitating event or factor that appears to cause the condition so it is presumed to stem from an internal process in the body

What are some facts about depression?

* International studies show that lifetime prevalence for one or more major depressive episodes is 15% (10% for males and 20% for females)
* Women might be more likely to develop depression than men because they have more hormonal changes across their life e.g. menstrual, pregnancy and menopause. Also, sociably women face more challenges in society e.g. women not being able to access abortion in the US
* Most commonly develops in early adulthood. This is such a common time for depression to develop because it is a time in life that is very stressful as you experience a lot of change
* Older people are very vulnerable to depression - approx. 25% of all suicides involve people over the age of 65
* Risk factors include: Temperament, negative events on early childhood, having a close relative with depression, if you suffer from another disorder e.g. anxiety and anorexia.

What are the positives of using the DSM-5 to diagnose depression?

* It is possible to use DSM-5 in a more reliable way. Real-world clinical diagnosis is based on semi-structured interviews such as the structured clinical interview for DSM-5. Shankman (2018) found 'substantial' reliability when using the SCID-5 to diagnose severity of major depressive disorder under the DSM-5 criteria. But, it is worth noting that such interviews usually go well beyond the criteria specified in the DSM-5 to reach the diagnosis.
* The DSM-5 does include a section on how to conduct a Cultural Formulation Interview which gives information about how a person's cultural identity may affect the expression of signs and symptoms. This gives information about what is normal in an individual's culture and what behaviours and attitudes are not due to cultural concerns. These should help clinicians make more valid diagnoses for disorders subject to significant cultural variation because they identify what is part of a culture and what stands out as a symptom of depression

What are the negatives of using the DSM-5 to diagnose depression?

* A weakness of the DSM-5 for the diagnosis of depression is that it's unreliable. Field trials of the DSM-5 (Regier, 2013) used a measure of agreement called the kappa statistic. The value of this was just 0.28 for major depressive disorder, this means that there was full agreement for only 4-15% of diagnoses. Research and treatment are undermined if not even highly-trained and experienced specialists can make reliable diagnoses of depression using the DSM-5
* A weakness is that many cultures do not recognise depression as a disorder and do not have a word in their language which fully matched the English connotation. It doesn't mean depression does not exist in these cultures, just that it’s experienced in different ways. Watters (2010) says that some people may have 'stomach pain' or 'tightness in the chest' depending on whether they are Chinese, Iranian or Korean. In these cultures depression manifests itself in different ways. This means that a Western clinician might not diagnose depression in some people because the symptoms have a specific cultural form therefore meaning there are cultural differences in diagnosis